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Presentation
Quadrimodal Distribution of Death after Trauma: Predictors of Death in the Fourth Peak
UMass Center for Clinical and Translational Science Research Retreat
  • Heena Santry, University of Massachusetts Medical School
  • Christopher J. Wilbert, MedStar Harbor Hospital
  • Charles M. Psoinos, University of Massachusetts Medical School
  • Julie Flahive, University of Massachusetts Medical School
  • Aimee R. Kroll-Desrosiers, University of Massachusetts Medical School
  • Timothy A. Emhoff, University of Massachusetts Medical School
  • Catarina I. Kiefe, University of Massachusetts Medical School
Start Date
8-5-2013 12:30 PM
End Date
8-5-2013 1:30 PM
Description

Introduction: Patterns of death after trauma are changing due to diagnostic and treatment advances. We examined mortality in critically injured patients at risk of death after discharge.

Methods: We reviewed all critically injured (Injury Severity Score≥25 AND death in Emergency Room , death within 24hrs, OR ICU admission>24hrs) adults (age≥18) admitted to a Level 1 trauma center (01/01/2000-12/31/2010) and determined death post-discharge (Social Security Death Index) of patients discharged alive. We compared demographics, injury data, and critical care resource utilization between those who died during follow-up and survivors using univariate tests and Cox proportional hazards models.

Results: Of 1,695 critically injured patients, 1135 (67%) were discharged alive. As of 05/1/2012, 977 (58%) index survivors were alive (median follow-up 62mos (IQR35,96)). Of 158 deaths post-discharge, 75 (47%) occurred within the first year. Patients who died post-discharge had longer hospital (24dys (IQR13,38) vs. 17dys (IQR10,27)) and ICU LOS (17dys (IQR6,29) vs. 8dys (IQR4,19)) and were more likely to undergo tracheostomies (36.1% vs. 15.6%, p16dys increased risk of death at one year (HR1.94 (1.22,3.06)) and by the end of follow-up (HR2.19 (1.58,3.04)) compared to shorter ICU stays.

Conclusion: We propose the first year after discharge as the fourth peak of trauma related mortality. Duration of ICU LOS during index hospitalization is associated with post-discharge mortality.

Creative Commons License
Creative Commons Attribution-Noncommercial-Share Alike 3.0
Citation Information
Heena Santry, Christopher J. Wilbert, Charles M. Psoinos, Julie Flahive, et al.. "Quadrimodal Distribution of Death after Trauma: Predictors of Death in the Fourth Peak" (2013)
Available at: http://works.bepress.com/catarina_kiefe/215/